Neurovascular Unit for Applied Translational and Therapeutics Research, Mater University Hospital/Dublin Academic Medical Centre, Dublin, Ireland.
Stroke. 2012 Aug;43(8):2042-7. doi: 10.1161/STROKEAHA.111.645721. Epub 2012 Jun 12.
The World Health Organization has emphasized the importance of international population-based data for unbiased surveillance of stroke incidence and outcome. To date, few such studies have been conducted using recommended gold-standard ascertainment methods. We conducted a large, population-based stroke study in Dublin, Ireland.
Using gold-standard ascertainment methods, individuals with stroke and transient ischemic attack occurring over a 12-month period (December 1, 2005-November 30, 2006) in North Dublin were identified. Disability was assessed using the modified Rankin score and stroke severity (<72 hours) by the National Institutes of Health Stroke Scale. Stroke-related deaths were confirmed by review of medical files, death certificates, pathology, and coroner's records. Crude and standardized (to European and World Health Organization standard populations) rates of incidence, risk factors, severity, and early outcome (mortality, case-fatality, disability) were calculated, assuming a Poisson distribution for the number of events.
Seven hundred one patients with new stroke or transient ischemic attack were ascertained (485 first-ever stroke patients, 83 recurrent stroke patients, 133 first-ever transient ischemic attack patients). Crude frequency rates (all rates per 1000 person-years) were: 1.65 (95% CI, 1.5-1.79; first-ever stroke), 0.28 (95% CI, 0.22-0.35; recurrent stroke), and 0.45 (95% CI, 0.37-0.53; first-ever transient ischemic attack). Age-adjusted stroke rates were higher than those in 9 other recent population-based samples from high-income countries. High rates of subtype-specific risk factors were observed (atrial fibrillation, 31.3% and smoking, 29.1% in ischemic stroke; warfarin use, 21.2% in primary intracerebral hemorrhage; smoking, 53.9% in subarachnoid hemorrhage; P<0.01 for all compared with other subtypes). Compared with recent studies, 28-day case-fatality rates for primary intracerebral hemorrhage (41%; 95% CI, 29.2%-54.1%) and subarachnoid hemorrhage (46%; 95% CI, 28.8%-64.5%) were greater in Dublin.
Using gold-standard methods for case ascertainment, we found high incidence rates of stroke in Dublin compared with those in similar high-income countries; this is likely explained in part by high rates of subtype-specific risk factors.
世界卫生组织强调了使用国际人群数据进行公正的卒中发病率和结局监测的重要性。迄今为止，很少有研究使用推荐的金标准确定方法进行此类研究。我们在爱尔兰都柏林进行了一项大型的基于人群的卒中研究。
使用金标准确定方法，确定了在都柏林北部 12 个月期间（2005 年 12 月 1 日至 2006 年 11 月 30 日）发生卒中及短暂性脑缺血发作的个体。使用改良 Rankin 评分评估残疾程度，发病后<72 小时使用国立卫生研究院卒中量表评估卒中严重程度。通过审查病历、死亡证明、病理学和验尸记录来确认与卒中相关的死亡。假设事件数量呈泊松分布，计算发病率、危险因素、严重程度和早期结局（死亡率、病死率、残疾）的粗率和标准化率（按欧洲和世界卫生组织标准人口标准化）。
共确定了 701 例新发卒中或短暂性脑缺血发作患者（485 例首发卒中患者，83 例复发卒中患者，133 例首发短暂性脑缺血发作患者）。粗发生率（所有率均为每 1000 人年发生率）为：1.65（95%CI，1.5-1.79；首发卒中）、0.28（95%CI，0.22-0.35；复发卒中）和 0.45（95%CI，0.37-0.53；首发短暂性脑缺血发作）。年龄调整后的卒中发生率高于其他 9 个来自高收入国家的近期基于人群的样本。观察到特定亚型危险因素的高发生率（缺血性卒中时心房颤动占 31.3%，吸烟占 29.1%；原发性脑出血时华法林使用率占 21.2%；蛛网膜下腔出血时吸烟占 53.9%；与其他亚型相比，所有比较均 P<0.01）。与近期研究相比，都柏林的原发性脑出血（41%；95%CI，29.2%-54.1%）和蛛网膜下腔出血（46%；95%CI，28.8%-64.5%）的 28 天病死率更高。
使用卒中病例确定的金标准方法，我们发现都柏林的卒中发病率高于其他类似高收入国家；这部分原因可能是特定亚型危险因素的高发生率所致。
